isosorbide dinitrate, Isordil Titradose, Dilatrate-SR, Isochron

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Pharmacy Author:

Omudhome Ogbru, PharmD

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

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Medical and Pharmacy Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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GENERIC NAME: isosorbide dinitrate

BRAND NAMES: Isordil Titradose, Dilatrate-SR, Isochron

DRUG CLASS AND MECHANISM: Isosorbide dinitrate is in the class of drugs called nitrates and it used for treating and preventing angina or heart pain. Other nitrates include nitroglycerin (Nitrostat, Nitroquick, Nitrolingual, Nitro-Dur and others) and isosorbide mononitrate (Imdur, Ismo, Monoket). Isosorbide dinitrate is converted in the body to isosorbide mononitrate which is the active chemical.

Nitrates are vasodilators (dilators of blood vessels). Blood returning from the body in the veins must be pumped by the heart through the lungs and into the body's arteries against the high pressure in the arteries. In order to accomplish this work, the heart's muscle must produce and use energy ("fuel"), and this requires oxygen. Angina pectoris (angina) or "heart pain" is due to an inadequate flow of blood (and oxygen) to the muscle of the heart. Nitrates, including isosorbide dinitrate, correct the imbalance between the flow of blood and oxygen to the heart and the work that the heart must do by dilating (expanding) the arteries and veins in the body. Dilation of the veins reduces the amount of blood that returns to the heart that must be pumped. Dilation of the arteries lowers the pressure in the arteries against which the heart must pump. As a consequence of both effects, the heart works less and requires less blood and oxygen.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets (sublingual): 2.5, 5, 10 mg. Tablets (immediate release): 5, 10, 20, 30, 40 mg. Tablets (extended release): 40 mg. Capsules (sustained release): 40 mg

STORAGE: Isosorbide dinitrate should be stored at room temperature, 15-30 C (59-86 F).

PRESCRIBED FOR: Isosorbide dinitrate is used for the treatment and prevention of angina caused by coronary artery disease. Only sublingual tablets are used for immediate treatment of angina because the onset of action of oral isosorbide dinitrate is not fast enough. Isosorbide dinitrate sometimes is used for treating congestive heart failure.

DOSING: Isosorbide dinitrate tablets can be taken with or without food. The sublingual tablets should be dissolved under the tongue and should not be crushed or chewed. Tolerance (reduced effect after several doses) may develop, so a drug free period of at least 14 hours is recommended. The recommended doses of isosorbide dinitrate are:

• Tablets: 5-40 mg 2 or 3 times daily
• Tablets: (sublingual): 2.5-10 mg
• Tablets: (extended-release) and capsules (sustained-release): 40-80 mg once or twice daily.

DRUG INTERACTIONS: Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) increase the blood pressure lowering effects of isosorbide dinitrate and may cause excessive blood pressure reduction. Patients taking isosorbide dinitrate should not receive sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra). Severe blood pressure reduction, especially when changing posture, may occur when isosorbide dinitrate is combined with calcium channel blockers, for example, diltiazem (Cardizem, Tiazac, etc.) and verapamil (Calan, Verelan, etc.) which also reduce blood pressure.

PREGNANCY: There are no adequate studies of isosorbide dinitrate in pregnant women.

NURSING MOTHERS: It is not known if isosorbide dinitrate is excreted in human breast-milk.

SIDE EFFECTS: Headaches are the most common side effect and usually are dose-related (increase with higher doses). Flushing may occur because isosorbide dinitrate dilates blood vessels. Isosorbide dinitrate may cause a drop in blood pressure when rising from a sitting position (orthostatic hypotension), causing dizziness, palpitations, and weakness. To reduce the risk of these side effects, patients should rise slowly from a sitting position.

Reference: FDA Prescribing Information

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